The Latest Threat to Immigrant Child Health: Public Charge AAP - - PowerPoint PPT Presentation

The Latest Threat to Immigrant Child Health: Public Charge

AAP Webinar Tuesday, October 30, 2018

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Immigrant Child Health

Colleen Kraft, MD, MBA, FAAP President, American Academy of Pediatrics

In several letters to the Department of Homeland Security, the American Academy of Pediatrics has urged an end to parent-child separation, which researchers have said can cause lifelong trauma in children.

AAP IMMIGRATION ADVOCACY

• Grounded in our mission and

policy

• Engaged in advocacy on family

separation, family detention, DACA, enforcement at sensitive locations, and more

• Public charge is the latest threat

PUBLIC CHARGE ADVOCACY

• Preparing for release of the rule

since 2017

• Met with White House Office of

Management and Budget to push for delay in publication of rule

• AAP chapter/member engagement
• Health care sector lead of the

Protecting Immigrant Families Campaign

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The Public Charge Proposed Rule And What it Means for Immigrant Families American Academy of Pediatrics October 30, 2018

Sonya Schwartz Senior Policy Attorney National Immigration Law Center schwartz@nilc.org

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The Protecting Immigrant Families Advancing Our Future Campaign

Created in 2017 and Co-Chaired by: Purpose: Unite to protect and defend access to health care, nutrition programs, public services and economic supports for immigrants and their families at the local, state and federal level.

• More than 280 Active Member Organizations
• 5 Working Groups: Communications, Federal

Advocacy, Field, Policy & Legal Analysis, Research

• Click here to see PIF Campaign overview

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Questions I will address

• What does this policy look like today?
• What would change under the draft proposed

regulation?

• How should we talk about public charge

with immigrant families?

• How can you weigh in on these changes?

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What does public charge policy look like today?

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When does the public charge test come up?

A public charge assessment is made when a person:

• Applies to enter the U.S.
• Applies to adjust status to

become a Lawful Permanent Resident (LPR)

• A green card holder leaves the

U.S. for more than 180 consecutive days (6 months) and reenters Public charge assessment is NOT made when a person:

• Applies to become a U.S. citizen
• Falls under certain categories of

immigrants, including refugees, asylees, people fleeing domestic violence and more.

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Current public charge test

Definition “Public Charge” is a term used by U.S. immigration officials to refer to a person who is considered likely to become primarily dependent on the government for subsistence. Totality of Circumstances Test ✓Age ✓Health ✓Family status ✓Financial status ✓Education and skills ✓Affidavit of support Pre-NPRM Benefits Considered Only two types of benefits considered:

• 1. Cash assistance for

income maintenance

• 2. Institutionalization

for long-term care at government expense

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How would the public charge test change under the proposed regulation?

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Changes in proposed regulation

New definition of “public charge” Totality of Circumstances test has new detailed negative factors that make it harder for low and moderate income people to pass Additional public benefits included

1 2 3

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Definition of public charge

Currently A person “likely to become primarily dependent on the government for subsistence As Proposed An immigrant “who receives one

• r more public benefits”

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Totality of Circumstances Test:

Heavily Weighed Factors

Heavily Weighed Positive Factors

Heavily Weighed Negative Factors

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Public benefits included

*Cash Support for Income Maintenance *Long Term Institutional Care at Government Expense **Non-Emergency Medicaid Supplemental Nutrition Assistance Program (SNAP or Food Stamps) Medicare Part D Low Income Subsidy Housing Assistance (Public Housing or Section 8 Housing Vouchers and Rental Assistance)

* Included under current policy as well ** Exception for certain disability services offered in school. DHS is asking for input on inclusion of CHIP, but the program is not included in the regulatory text

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Public benefits not included

Any other benefit not specifically listed in the regulation is not included

• Disaster relief
• Emergency medical assistance
• Entirely state local or tribal

programs (other than cash assistance)

• Benefits received by immigrant’s

family members

• CHIP*

*DHS is asking for input on inclusion of CHIP, but the program is not included in the regulatory text.

• Women Infants and Children (WIC)
• School Breakfast and Lunch
• Energy Assistance (LIHEAP)
• Transportation vouchers or non

cash transportation services

• Non-cash TANF benefits
• Federal Earned Income Tax Credit

and Child Tax Credit

• Student Loans

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Totality of Circumstances Test: Other Factors

Age Health Family Status Income and Financial Status Education and Skills Affidavit of Support

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Totality of Circumstances Test: Family Status

• Receipt of benefits by dependents

(including U.S. citizen children) will not directly be a factor in applicant’s public charge test.

• If a child or family member is an

immigrant, his/her own use of benefits counts toward his/her own public charge determination.

• Dependents are included in the calculation
• f household size and may make it harder

for immigrants to meet the income test.

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Who would the proposed regulation harm?

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Impact of the proposed regulation

As many as 26 million people in families with immigrants might be chilled from participating in programs that make their families healthier and stronger.

1 in 4 children have an immigrant parent

Source: Samantha Artiga and Anthony Damico“Nearly 20 Million Children Live in Immigrant Families that Could Be Affected by Evolving Immigration Policies” Kaiser Family Foundation, 2018 Source “Public Charge Proposed Rule: Implications for Non-Citizens and Citizen Family Members Data Dashboard,” Manatt Health, October 2018

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Impacts of the proposed regulation

Impacts by race and ethnicity

• 18.3 million LATINOS
• 33.4% of all LATINOS
• 3.2 million ASIAN & API
• 17.4% of all ASIAN & API
• 1.8 million BLACK & AFRICAN
• 4% of all BLACK & AFRICAN
• 2.5 million WHITES
• 1% of all WHITES

Source: “Public Charge Proposed Rule: Implications for Non-Citizens and Citizen Family Members Data Dashboard,” Manatt Health, October 2018

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Summary: Why the proposed policy is a radical change

Definition would change from someone who relies on government for main source of support to someone who participates in a health, nutrition or housing benefits to support work. Immigrants can fail totality of circumstances test if they are low income, don’t speak English well, receive an included benefit. Additional benefits included in the test: non-Emergency Medicaid, SNAP, Housing, Medicare Part D low-income subsidy

Definition Change More Gov Discretion Additional Benefits

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Keep in Mind

• Other than cash or long-term care, benefits used

before rule is final and effective will not be considered in the public charge determination.

• The existing 1999 public charge guidance is still in

place in the U.S. until a new rule is finalized.

• The proposed regulation may never be finalized or the

finalized regulation could look different from the proposed version.

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How can you talk to immigrant families about this?

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How can you talk to immigrant families about this?

• 1. The regulation is not final and you can speak out against it
• 2. The proposed regulation would not consider any newly listed benefits before it is final
• 3. The regulation does not apply to all immigrants
• 4. The privacy of your personal information is protected by law
• 5. You are not alone, and you can fight back!

Get help understanding how this would apply to you. For free or low-cost options, visit: www.immigrationadvocates.org/nonprofit/legaldirectory

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How can you weigh in on these changes?

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Help us reach 100,000 comments by December 10

High Quality Organizational Comments

• Who?
• State AAP Chapters and their

partners

• What?
• Edit template for health care sector

available soon, include state-specific information harm that would be caused

• Where?
• Regulations.gov

High Quantity Individual Comments

• Who?
• You and your colleagues and friends

and family

• What?
• Edit text on websites with a few

clicks, try to modify by 30% with stories, experiences, examples of harm that would be caused

• Where?
• AAP Toolkit (Tamar will share next)
• Protectingimmigrantfamilies.org
• OurAmericanStory.us/protecting-

health/

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Commenting About CHIP

Proposed Rule

Asks whether CHIP should be included in the list of public benefits immigration

• fficials consider

in a public charge determination.

Suggested Response

• The benefits of excluding both CHIP and Medicaid
• utweigh their inclusion.
• Would lead to children foregoing care because of

direct inclusion as well as the chilling effect

• Contrary to explicit Congressional intent under

CHIPRA Section 214 (2009) state option for lawfully residing children and pregnant women

• CHIP broad bipartisan support on recognition that

children need access to care to ensure their healthy development, has positive impact on health

• utcomes, economic well-being and productivity

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What else can you do?

HOW HAS AAP RESPONDED?

• Immediately issued a press

release

• Joined with America’s frontline

physician groups to respond

• All-member communications
• Public Charge Advocacy Toolkit

WHAT YOU CAN DO

• Submit Comments - Individual, chapter,

AAP by December 10

• Media - Opeds, social media, interviews
• NCE - Visit the Advocacy Action Center
• Toolkit – federaladvocacy.aap.org
• Additional Resources - Protecting

Immigrant Families Campaign at protectingimmigrantfamilies.org

PUBLIC CHARGE ADVOCACY TOOLKIT

federaladvocacy.aap.org

QUESTIONS?